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Individual

MRS. JENNY MAE KIRWIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW, LCAS, CCS

Contact information

Practice address
9339 CUB RUN DR, CONCORD, NC 28027-5404
(803) 627-2401
Mailing address
9339 CUB RUN DR, CONCORD, NC 28027-5404
(803) 627-2401

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
880
NC
1041C0700X
Clinical Social Worker
C003793
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6002794
NC
Enumeration date
09/16/2006
Last updated
12/17/2015
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